<table width="640" cellpadding="0" cellspacing="0">
	<tr>
		<td height="73">
		<p align="center"><strong>$msg_register</strong></p>
		</td>
	</tr>
	<tr>
		<td height="526">
		<form action='register_action' method=post>
		<table width="660" border=0 cellspacing="3">
			<tr>
				<td width="248">Nome / Raz&atilde;o Social</td>
				<td width="399"><input type=text name='name' size=50></td>
			</tr>
			<tr>
				<td>Endere&ccedil;o</td>
				<td><input type=text name='address' size=50></td>
			</tr>
			<tr>
				<td>Bairro</td>
				<td><select name="neighborhood">
					<option value="">-</option>
					<option value="Jardim Esperanca">Jardim Esperanca</option>
					<option value="Porto do Carro">Porto do Carro</option>
					<option value="Tangara">Tangara</option>
					<option value="Caminho de Buzios">Caminho de Buzios</option>
					<option value="Guriri">Guriri</option>
				</select></td>
			</tr>
			<tr>
				<td>CEP</td>
				<td><input type=text name='zip' size=50></td>
			</tr>
			<tr>
				<td>Telefone</strong></td>
				<td><input type=text name='telephone' size=15></td>
			</tr>
			<tr>
				<td>Celular</td>
				<td><input name='celular' type=text size=15></td>
			</tr>
			<tr>
				<td>E-mail</td>
				<td><strong> <input type=text name='contactemail' size=50> </strong></td>
			</tr>
			<tr>
				<td>CPF / CNPJ</td>
				<td><strong> <input type=text name='cpf' size=50> </strong></td>
			</tr>
			<tr>
				<td>Indentidade (RG)</td>
				<td><strong> <input type=text name='rg' size=50> </strong></td>
			</tr>
			<tr>
				<td>Qual nome de usu&aacute;rio deseja criar?</td>
				<td><strong> <input type=text name='email' size=36> </strong></td>
			</tr>
			<tr>
				<td>Digite uma senha</td>
				<td><strong> <input type=password name='password' size=36> </strong></td>
			</tr>
			<tr>
				<td>Confirme a senha</td>
				<td><strong> <input type=password name='checkpassword' size=36> </strong></td>
			</tr>
			<tr>
				<td height="20">&nbsp;</td>
				<td>&nbsp;</td>
			</tr>
			<tr>
				<td>&nbsp;</td>
				<td>&nbsp;</td>
			</tr>
			<tr>
				<td>&nbsp;</td>
				<td><input type=submit value='Cadastrar'> <input type=reset
					value='Apagar'></td>
			</tr>
		</table>
		</form>
		</td>
	</tr>
</table>
